The Infectious Diseases and Immunization Committee of the Canadian Paediatric Society made recommendations on the use of intravenous immune globulin (IglV) in children in 1992. Certain conditions were listed in which the efficacy of IglV has been established including replacement therapy in antibody deficiency states, immune thrombocytopenic purpura and Kawasaki disease. Other conditions were listed in which the efticacy of IglV was not yet established. Based on the quality of available data, these latter conditions were further divided into those in which IglV would probably or possibly prove to be efficacious. The committee resolved to update the statement as further studies on the use of IglV became available.
In the three years since publication of the guidelines, several studies of the efticacy of IglV therapy have been retported. These studies have led the committee to modify its recommendations. Well controlled studies were published evaluating the use of IglV in adults with Guillain-Barre syndrome and other polyneuropathies. In patients with Guillain-Barre syndrome, recovery was improved and hasttened by IglV therapy, and there were fewer complications and decreased need for artificial ventilation. Another well designed study in adults showed a significant benefit of IglV for treatment of refractory dermatomyositis.
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A large multicentred, placebo controlled, double-blind study of IglV therapy in children with symptomatic human immunodeficiency virus (hiv) intection demonstrated that prophylactic use of IglV increased the time free from setious bacterial intection and minor bacterial and vi tal intections. The study was limited to children under 13 years of age without hemophilia; most were under five years of age and had acquired hiv intection by vertical transmission from infected mothers. The protective effect of IglV was limited to children who entered the study with CD4 counts of 0.2×109/L or more; there were too few children with lower CD4 counts to show any beneficial effect, or there may be no effect in this group. Irrespective of CD4 counts, there was no significant effect of IglV therapy on overall mortality. More recently, another large multicentred, randomized, placebo controlled, doubleblind study demonstrated a beneticial effect of prophylactic IglV therapy only in HIV-infected children who were not receiving trimethoprim-sulphamethoxazole therapy. The authors hypothesized that lower rates of zidovudine use and trimethoprim-sulphamethoxazole prophylaxis for Pneumocystis carinii pneumonia in the earlier study may have contributed to the differences in the findings.